Crusted scabies in a pediatric renal transplant recipient on immunosuppressants

Abstract

Background Crusted scabies (CS) is a rare, severe and highly contagious form of scabies, which has been reported in immunosuppressed patients. A high index of suspicion and awareness of CS is essential to treat this infestation. Case A 13‐year‐old boy presented with pruritic hyperkeratotic squamous plaques located on both inner wrists, the web spaces of both his hands and his feet, and the genital area of 12 months duration. He was diagnosed with focal segmental glomerulosclerosis at the age of 5 and received a kidney transplant at the age of 9. He has been on a maintenance dose of prednisone (5 mg/d) and mycophenolate mofetil (250 mg/d) for the past 2 years. He had a contact history with a school friend with similar lesions. A skin punch biopsy demonstrated the presence of multiple mites in the stratum corneum confirming the diagnosis of CS. Ivermectin, the recommended drug of choice for crusted scabies, is not available in South Africa. The patient was commenced on topical benzoyl benzoate lotion but discontinued its use because of intolerable irritation. We subsequently prescribed the daily application of topical 5% sulfur in petrolatum to which his pruritus subsided significantly after 2 weeks with resolution of all skin lesions at the end of 8 weeks. Conclusion This case is the first documented report of CS in a pediatric renal transplant patient. Our management highlights that classic formularies of magistral drugs are still effective treatment options and can be used especially when standard therapies cannot be tolerated or when optimum treatments are not available.

Ancient Disease Making a Comeback Due to Covid-19 Pandemic

“…[ 1 ] Its risk factors include increased age, dementia, down's syndrome, human immunodeficiency virus infection, leprosy, lymphoma, systemic lupus erythematosus, long-term corticosteroid/immunosuppressants use. [ 2 ] None of the above mentioned causes were present in our case. Perhaps, the delay in seeking treatment, misdiagnosis, delayed development of scratch reflex, and past treatment with topical corticosteroids could be possible contributing factors to the increased severity of disease.…”

Common pediatric infestations: update on diagnosis and treatment of scabies, head lice, and bed bugs

“…Transmission through fomites is more likely to be involved in crusted (Norwegian) scabies where hundreds of mites result in pruritic hyperkeratotic plaques. High mite loads can be seen in children living in crowded, under-resourced conditions, in immunocompromised states, or as a result of immunotherapy [3][4][5]. The clinical manifestation of a scabies infestation varies by age and often overlaps with other dermatologic diseases, making it difficult to diagnose.…”